The Unintended Consequences of Public Reporting

As other chapters in this book so eloquently demonstrate, the field of pediatric cardiology and cardiac surgery is one that is fraught with bioethical controversy. This moral maze, already difficult to navigate, has become even more hazardous with the addition of a new dragon which has arisen out of the pitfalls of transparency. Better and more complete data collection in cardiology and cardiac surgery generally has led to increasingly clamorous demands for the outcome data to be published, so that patients are better able to choose who operates on them and where. With the best intentions in mind, the medical profession in many advanced nations has, at times enthusiastically and at others reluctantly, increasingly complied with these demands. Transparency is, of course, ‘a good thing’ but the law of unintended consequences has come into play and certain highly undesirable behaviors have appeared which have caused damage to patients and doctors alike.